Question 1

On a 2-week follow-up visit to the health care provider,a 64-year-old female postoperative client shares with the nurse that she is having difficulty sleeping and has never had a history of sleeping problems.The nurse shares with the client that:
A) Because of her age,the client should expect to begin having some problems sleeping
B) It may take a while to get used to sleeping in her bed at home after getting used to sleeping on a hospital bed
C) The medications used for anesthesia can disturb sleep cycles for several weeks following surgery
D) She may not be sleeping as well with her partner after being in a bed by herself while being hospitalized

Accepted Answer

If the client has recently had surgery,expect the client to experience some disturbance in sleep.Clients usually awaken frequently during the first night after surgery and receive little deep or REM sleep.Depending on the type of surgery,it takes several days to months for a normal sleep cycle to return.

Question 2

A client hospitalized for a myocardial infarction in a cardiac critical care unit (CCU)is most likely to experience sleep deprivation as a result of:
A) A drug-disrupted circadian sleep pattern
B) Generally diminished cardiac output
C) Unfamiliar environmental stimuli
D) Increased emotional stressors

Accepted Answer

Hospitalization,especially in intensive care units,makes clients particularly vulnerable to the extrinsic and circadian sleep disorders that cause the "ICU syndrome of sleep deprivation." Constant environmental stimuli within the intensive care unit (ICU),such as strange noises from equipment,the frequent monitoring and care given by nurses,and ever-present lights,confuse clients and lead to sleep deprivation.Although the other options may be contributing factors,they are not as directly responsible.

Question 3

The night nurse goes quietly into the sleeping client's room to assess him.The client wakes up as soon as the nurse is in the room.The nurse knows that the client was most likely in which stage of sleep?
A) Stage 1: NREM
B) Stage 2: NREM
C) Stage 3: NREM
D) Stage 4: NREM

Accepted Answer

Stage 1 NREM includes the lightest level of sleep.Sensory stimuli such as noise easily arouses the person.The stage lasts a few minutes.Decreased physiological activity begins with gradual fall in vital signs and metabolism.Awakened,person feels as though daydreaming has occurred.Stage 2 NREM is a period of sound sleep.Stage 3 NREM involves initial stages of deep sleep.Stage 4 NREM is the deepest stage of sleep.It is very difficult to arouse the sleeper.

Question 4

Which of the following clients experiencing disrupted sleep patterns is most at risk for obstructive sleep apnea (OSA)?
A) A 15-year-old boy with type 1 diabetes
B) A 22-year-old diagnosed with Crohn's disease
C) A 49-year-old man who is an avid cross-county runner
D) A 58-year-old woman diagnosed with chronic depression

Accepted Answer

Many think OSA affects middle-age men more frequently,particularly when they are obese.However,obstructive sleep apnea is also common in postmenopausal women,younger women,and children.Although the clients in all of the options may experience OSA,the postmenopausal woman has the greatest risk.

Question 5

A 73-year-old male client who normally sleeps on his right side recently underwent a right-side hip replacement surgery and now has trouble sleeping.One of the interventions that the nurse might try with this client is to:
A) Request medication to help the client sleep while in the hospital
B) Carefully prop the client on his operative side using pillows to support the hip
C) Schedule therapy for the evening to help the client become tired so he can sleep
D) Question the client to learn more about his normal sleep pattern

Accepted Answer

Knowing a client's usual,preferred sleep pattern allows a nurse to try to match sleeping conditions in a health care setting with those in the home.

Question 6

A 25-year-old client's wife complains to the nurse that he sleepwalks during the night.The nurse knows that this behavior normally occurs in which stage of sleep?
A) Stage 2: NREM
B) Stage 3: NREM
C) Stage 4: NREM
D) REM

Accepted Answer

Stage 4 NREM sleep is the deepest stage of sleep.It is very difficult to arouse the sleeper.If sleep loss has occurred,the sleeper will spend a considerable portion of the night in this stage.Vital signs are significantly lower than during waking hours.The stage lasts approximately 15 to 30 minutes.Sleepwalking and enuresis (bed-wetting)sometimes occur.Stage 2 NREM is a period of sound sleep.Stage 3 NREM involves initial stages of deep sleep.REM sleep involves vivid,full-color dreaming.Loss of skeletal muscle tone occurs.It is very difficult to arouse the sleeper.Less vivid dreaming occurs in other stages.The stage is typified by autonomic response of rapidly moving eyes,fluctuating heart and respiratory rates,and increased or fluctuating blood pressure.

Question 7

A nurse caring for a patient prior to surgery should recognize which of the following factors place a client at risk for obstructive sleep apnea? (Select all that apply. )
A) Heart disease
B) Respiratory tract infections
C) Nasal polyps
D) Obesity

Accepted Answer

Structural abnormalities,such as a deviated septum,nasal polyps,certain jaw configurations,or enlarged tonsils predispose a client to obstructive apnea.Individuals with mixed apnea often have signs and symptoms of right-sided heart failure.Respiratory tract infections do not predispose a client to obstructive sleep apnea.Clients with obstructive apnea are often middle-age,obese men.Obesity itself does not predispose a client to obstructive sleep apnea.

Question 8

The nurse and the parents of a 3-year-old are discussing their child's sleep habits.They share a concern over the child's tendency to wake up several times during the night crying out loudly but not really being awake.The nurse addresses the parents' concern most therapeutically by responding:
A) "Have you ever tried reading a bedtime story before putting her to bed?"
B) "If she does that only a few times a week,I wouldn't be too overly concerned."
C) "Children her age often become poor sleepers.Have you discussed this with her pediatrician?"
D) "It is common for children to have trouble relaxing,and this behavior is the result.It's usually temporary."

Accepted Answer

The preschooler usually has difficulty relaxing or quieting down after long,active days and has problems with bedtime fears,waking during the night,or nightmares.Partial wakening followed by normal return to sleep is frequent.In the waking period,the child exhibits brief crying,walking around,unintelligible speech,sleepwalking,or bed-wetting.The other options either ask questions or provide possible tactics for preventing the problems.

Question 9

A 22-year-old male client shares with the nurse that he is always tired.In assessing the client's sleep pattern to determine the quantity of sleep the client is getting,the nurse should ask:
A) "On a scale from 0 to 10,how much sleep to you think you get each night?"
B) "What time do you usually go to bed?"
C) "What time do you usually get up?"
D) "Do you have a bedtime ritual?"

Accepted Answer

This question helps quantify the length of sleep that the client receives.A brief subjective method to assess sleep is a numeric scale with a 0 to 10 sleep rating.Ask individuals to separately rate their quantity and quality of sleep on the scale.Instruct clients to indicate with a number between 0 and 10 their sleep quantity then their quality of sleep with 0 being the worst sleep and 10 being the best sleep

Question 10

Which of the following clients is most likely to experience difficulty returning to sleep?
A) A 60-year-old with benign hypertropic prostatic disease
B) A 15-year-old with type 1 diabetes
C) A 35-year-old diagnosed with hypothyroidism
D) A 55-year-old diagnosed with hypertension

Accepted Answer

Nocturia,or urination during the night,disrupts sleep and the sleep cycle.This condition is most common in older people with reduced bladder tone or persons with cardiac disease,diabetes,urethritis,or prostatic disease.After a person awakens repeatedly to urinate,returning to sleep is difficult.Although all the clients may have difficulty falling back to sleep when awakened,the answer represents the client with the greatest tendency to be awakened during the night.

Question 11

A 70-year-old client is reporting to the nurse a concern over "taking longer to fall asleep and waking up three to four times during the night." The most therapeutic nursing response to the client's concern is:
A) "I think you need to mention your concerns to your health care provider."
B) "Older adults seem to need less sleep.Do you still feel rested in the morning?"
C) "I suggest that you plan for a nap in the afternoon to make up for that missed sleep."
D) "As we age,those kinds of problems seem more common.Does this disruption in your sleep cause you to be tired or irritable?"

Accepted Answer

An older adult awakens more often during the night,and it takes more time for an older adult to fall asleep.The answer provides an opportunity for a discussion about the effect this problem may be creating.

Question 12

The client asks the nurse,"How will I know if I'm really rested?" The nurse's most therapeutic response is:
A) "Everyone's definition of rested is different.How would you define rested?"
B) "When you aren't tired when you get up in the morning or after an afternoon nap."
C) "When you are mentally,physically,and emotionally ready to go about your daily activities."
D) "You are rested if you fall asleep easily and sleep uninterruptedly for at least 6 to 8 hours."

Accepted Answer

When people are at rest they are in a state of mental,physical,and spiritual activity that leaves them feeling refreshed,rejuvenated,and ready to resume the activities of the day.The remaining options ask questions or provide a limited view on what rested means.

Question 13

A 63-year-old client is discussing the recent problem the client is experiencing with falling asleep.The nurse is discussing strategies to minimize this problem.Which of the following bedtime snacks would be the most likely to induce sleep?
A) One slice of cheese on four wheat crackers and a glass of skim milk
B) Two cups of air-popped popcorn and a glass of fruit juice
C) Two fig cookies and a cup of decaffeinated tea
D) One small pear and a glass of soymilk

Accepted Answer

One substance that promotes sleep in many people is L-tryptophan,a natural protein found in foods such as milk,cheese,and meats.

Question 14

A 44-year-old female client shares with the nurse that she is having difficulty falling asleep at night,even though she is exhausted.The nurse knows that which of the following could be causing the sleeplessness?
A) Two cups of hot cocoa every evening
B) Vegetarian diet
C) Afternoon exercise program
D) Hot bath in the evening

Accepted Answer

Caffeine is a stimulant and can cause difficulty in falling asleep.There is about 30 mg of caffeine in two cups of hot cocoa.

Question 15

The nurse is discussing child care strategies with a mother of a newborn.The mother asks the nurse,"What causes sudden infant death syndrome (SIDS)?" Which of the following responses is most likely to answer the mother's question therapeutically?
A) "SIDS is a common fear for new mothers.The best advice is to put your baby to sleep on her back."
B) "We aren't sure exactly,but it may have something to do with undetected cardiac or oxygen problems."
C) "Research is inconclusive,but it's thought to be a result of a nervous system problem that occurs when the baby is asleep."
D) "Your pediatrician wants you to put your baby to sleep on her back because research has shown that more stomach sleepers are victims."

Accepted Answer

Some have hypothesized that sudden infant death syndrome (SIDS)is caused by abnormalities in the autonomic nervous system that are manifested during sleep,resulting in apnea,hypoxia,and/or cardiac dysrhythmias.This answer provides the most thorough answer to the mother's question,whereas the remaining options stress preventive measures.

Question 16

The nurse is caring for a 35-year-old father of three young children who has experienced a compound fractured femur as a result of a work-related incident.He has expressed great concern over both his physical recovery and his long-term ability to work again.This has affected both his emotional status and his sleeping patterns.The nurse's most immediate concern is that:
A) The client needs medication to prevent depression
B) The lack of appropriate rest will affect his healing process
C) An occupational therapy consult should be ordered to help him regain his ability to return to his job
D) A psychiatric consult should be ordered to help the client deal with his various emotional concerns

Accepted Answer

You must always be aware of the client's need for rest.A lack of rest for long periods causes illness or worsening of existing illness.Although the other options are appropriate concerns,they are not as immediate in nature as is the sleep problem.

Question 17

A client shares with the nurse that "My wife complains about my snoring,and I never really feel rested." Which of the following responses best attempts to explain the cause of the problem to the client?
A) "Sleep disturbances can really affect all aspects of your life.How long have you been experiencing this problem?"
B) "You need to get help to breathe more effortlessly at night so both you and your wife can get sufficient deep stage sleep."
C) "Something is interfering with your ability to breathe while you are asleep.Have you talked with your health care provider about the problem?"
D) "Your upper airway is blocked,and that is making it difficult for you to breathe effectively,so you are spending most of the night in the light sleep stage."

Accepted Answer

The upper airway becomes partially or completely blocked,and diminished nasal airflow (hypopnea)can result for as long as 30 seconds.The person attempts to breathe,which often results in loud snoring and snorting sounds.The effort to breathe during sleep results in arousals from deep sleep,often to the stage 2 cycle,causing interference with deep sleep and thus the client's not feeling rested.The remaining options are not inappropriate,but they are not as directed at explaining the problem to the client.

Question 18

A female client describes the most elaborate dreams to the nurse.She states that she could see colors,hear music,and even had the sensation of flying.The nurse replies to the client that her dreams indicate that she must be:
A) Depressed
B) Pragmatic
C) Creative
D) Mentally ill

Accepted Answer

Personality influences the quality of dreams;for example,a creative person has elaborate and complex dreams,whereas a depressed person dreams of helplessness.Most people dream about immediate concerns such as an argument with a spouse or worries over work.Sometimes a person is unaware of fears represented in bizarre dreams.

Question 19

The assistive nursing personnel reports that the heart rate of the sleeping 23-year-old athlete,who is hospitalized following complications of a tonsillectomy,is 56.The assistive nursing personnel states that this is 10 beats per minute slower than when she took it earlier in the evening.The nurse knows that this is considered:
A) Normal,and they will continue to monitor the vital signs as ordered
B) Abnormally slow,and the health care provider should be notified immediately
C) Abnormally slow,and the nurse will recheck the heart rate before taking any action
D) Abnormally slow,signaling that the client may be hemorrhaging

Accepted Answer

A healthy adult's normal heart rate throughout the day averages 70 to 80 beats per minute or less if the individual is in excellent physical condition.However,during sleep the heart rate falls to 60 beats per minute or less.This means that the heart beats 10 to 20 fewer times in each minute during sleep or 60 to 120 fewer times in each hour.If the client were hemorrhaging,the heart rate would initially be tachycardic as the body attempts to compensate for the lost blood volume.

Quiz 42: Sleep

On a 2-week follow-up visit to the health care provider,a 64-year-old female postoperative client shares with the nurse that she is having difficulty sleeping and has never had a history of sleeping problems.The nurse shares with the client that:

A client hospitalized for a myocardial infarction in a cardiac critical care unit (CCU) is most likely to experience sleep deprivation as a result of:

The night nurse goes quietly into the sleeping client's room to assess him.The client wakes up as soon as the nurse is in the room.The nurse knows that the client was most likely in which stage of sleep?

Which of the following clients experiencing disrupted sleep patterns is most at risk for obstructive sleep apnea (OSA) ?

A 73-year-old male client who normally sleeps on his right side recently underwent a right-side hip replacement surgery and now has trouble sleeping.One of the interventions that the nurse might try with this client is to:

A 25-year-old client's wife complains to the nurse that he sleepwalks during the night.The nurse knows that this behavior normally occurs in which stage of sleep?

A nurse caring for a patient prior to surgery should recognize which of the following factors place a client at risk for obstructive sleep apnea? (Select all that apply. )

The nurse and the parents of a 3-year-old are discussing their child's sleep habits.They share a concern over the child's tendency to wake up several times during the night crying out loudly but not really being awake.The nurse addresses the parents' concern most therapeutically by responding:

A 22-year-old male client shares with the nurse that he is always tired.In assessing the client's sleep pattern to determine the quantity of sleep the client is getting,the nurse should ask:

Which of the following clients is most likely to experience difficulty returning to sleep?

A 70-year-old client is reporting to the nurse a concern over "taking longer to fall asleep and waking up three to four times during the night." The most therapeutic nursing response to the client's concern is:

The client asks the nurse,"How will I know if I'm really rested?" The nurse's most therapeutic response is:

A 63-year-old client is discussing the recent problem the client is experiencing with falling asleep.The nurse is discussing strategies to minimize this problem.Which of the following bedtime snacks would be the most likely to induce sleep?

A 44-year-old female client shares with the nurse that she is having difficulty falling asleep at night,even though she is exhausted.The nurse knows that which of the following could be causing the sleeplessness?

The nurse is discussing child care strategies with a mother of a newborn.The mother asks the nurse,"What causes sudden infant death syndrome (SIDS) ?" Which of the following responses is most likely to answer the mother's question therapeutically?

A client shares with the nurse that "My wife complains about my snoring,and I never really feel rested." Which of the following responses best attempts to explain the cause of the problem to the client?

A female client describes the most elaborate dreams to the nurse.She states that she could see colors,hear music,and even had the sensation of flying.The nurse replies to the client that her dreams indicate that she must be: